Difference between revisions of "Levamisole toxicity"

(Text replacement - " pts" to " patients")
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==Background==
 
==Background==
*an antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects  
+
*An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects  
 
*Increasingly used as a cutting agent in cocaine sold around the globe
 
*Increasingly used as a cutting agent in cocaine sold around the globe
 
**69% of DEA seized cocaine contained levamisole (2009)<ref> Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234</ref>
 
**69% of DEA seized cocaine contained levamisole (2009)<ref> Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234</ref>
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==Clinical Features==
 
==Clinical Features==
*agranulocytosis/thrombocytopenia
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*Agranulocytosis/Thrombocytopenia
**typically neutropenia
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**Typically neutropenia
**tends to reverse spontaneously when discontinued
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**Tends to reverse spontaneously when discontinued
*levamisole induced necrosis syndrome
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*Levamisole induced necrosis syndrome
 
**Necrotic patches anywhere on skin (especially ears and legs)
 
**Necrotic patches anywhere on skin (especially ears and legs)
*leukoencephalopathy
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*Leukoencephalopathy
**seen when used as a pharmaceutical in past
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**Seen when used as a pharmaceutical in past
**no cases described associated with cocaine adulteration
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**No cases described associated with cocaine adulteration
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==

Revision as of 19:47, 21 June 2016

Background

  • An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects
  • Increasingly used as a cutting agent in cocaine sold around the globe
    • 69% of DEA seized cocaine contained levamisole (2009)[1]
  • Results in Levamisole induced necrosis syndrome[2]

Clinical Features

  • Agranulocytosis/Thrombocytopenia
    • Typically neutropenia
    • Tends to reverse spontaneously when discontinued
  • Levamisole induced necrosis syndrome
    • Necrotic patches anywhere on skin (especially ears and legs)
  • Leukoencephalopathy
    • Seen when used as a pharmaceutical in past
    • No cases described associated with cocaine adulteration

Differential Diagnosis

Workup

  • CBC

Management

  • Neutropenia
  • Necrosis
    • Aggressive supportive care
    • Burn care if significant necrosis
  • Avoid cocaine re-exposure
    • 27% of patients had symptom recurrence with cocaine re-exposure[3]

Disposition

Admission

See Also

External Links

Sources

  1. Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234
  2. http://www.ncbi.nlm.nih.gov/pubmed/20668440
  3. Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234